Quote from jbp0529
The other day we had a patient who was scheduled to have procedure during the day shift, yet bc of lab results, the procedure was held. During the night, the patient arrested, the procedure done at the bedside stat and we got a rhythm/pulse back. However the pt had been down for quite some time and neurological status was very questionable. Turned out the pt had an advanced directive which we didnt know about. So now we (mainly the docs) were faced with a dilemma... to honor the pt's wishes and urge for the family to withdraw care, or continue treatment now that the pt is "stabilized" somewhat. What does/would one do in that situation? What do u think the family should do?
One important thing we often forget is that these families need to feel that they've given their loved one the best chance at a recovery. It is often hard to give these families at straight answer on prognosis, length of recovery, quality of life if they do live through a period of being sick in the ICU. I personally can't tell you how many I have seen in my few years in the unit and thought they would never make it out of the unit much less the hospital, and they make a full recovery. Granted, the chronic long termers usually don't fare so well, but you never know. I know the families often feel torn between wanting to do what the patient wants, but also not wanting to give up. Nothing would be harder than letting your mom/dad/grandparent go and wondering if you would have continued with treatment if somehow they could have made it.
Now, all that said, I also think we come to a point when enough is enough. I understand the families that choose to keep going with treatment when there is a feasible chance of recovery, but I have a harder time understanding those who come in with multiple admissions for end stage COPD, fibrotic lungs, chronic CHF with no heart left and the families refuse to recognize they are prolonging the inevitable and making their loved one continue to suffer because they can't let go.
I think it is a situational thing- each member of the healthcare team must be evaluating the patient and response to treatment on a continual basis with realistic expectations and have frank open discussions to ensure the families understand exactly what is going on. Unfortunately, often these families don't understand half what we tell them, and the half they do understand, they still don't grasp the overall picture of how sick their family member is. I think in these situations, we still have a long way to go with effective communication.